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Meta-Analysis
. 2019 Jul 15;17(1):130.
doi: 10.1186/s12916-019-1369-7.

Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis

Hilary Shepherd  1 , Gill Livingston  1   2 , Justin Chan  1 , Andrew Sommerlad  3   4
Affiliations
Meta-Analysis

Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis

Hilary Shepherd et al. BMC Med. .

Abstract

Background: Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. However, no intervention has yet reduced admissions of community-dwelling people with dementia. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia and to identify socio-demographic and clinical predictors of hospitalisation.

Methods: We searched MEDLINE, Embase, and PsycINFO from inception to 9 May 2019. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. non-psychiatric) hospital admissions. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. Three authors graded evidence strength using Cochrane's GRADE approach, including assessing for evidence of publication bias using Begg's test. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia.

Results: We included 34 studies of 277,432 people with dementia: 17 from the USA, 15 from Europe, and 2 from Asia. The pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. Hospitalisation rates in people with dementia were between 0.37 and 1.26/person-year in high-quality studies. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. There was strong evidence that dementia severity alone is not associated.

Conclusions: People with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. Future interventions to reduce unnecessary hospitalisations should target potentially modifiable factors, such as polypharmacy and functional ability, in high-risk populations.

Keywords: Dementia; Healthcare utilisation; Hospitalisation; Prognosis; Risk factors.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/conflicts-of-interest/ and declare HS reports funds from the UCL Dementia Scholarship 2017. GL has grants from the National Institute for Health Research (NIHR)/Economic and Social Research Council, NIHR Health Technology Assessment and Alzheimer’s Society and is supported by the North Thames NIHR Collaboration for Leadership in Applied Health Research and Care. AS reports grants from the Wellcome Trust. GL and AS are supported by the University College London Hospitals NIHR Biomedical Research Centre.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of included studies
Fig. 2
Fig. 2
Forest plot of studies examining relative risk of hospitalisation for people with dementia compared to those without dementia, adjusted for age, sex, and physical comorbidity. Note: weights are derived from random effects meta-analysis
Fig. 3
Fig. 3
a Association of demographic characteristics of people with dementia or caregivers and hospitalisation: relative risk of admission and confidence in evidence. b Association of clinical characteristics of people with dementia and hospitalisation: relative risk of admission and confidence in evidence. Note: full information on risk factor classification and evidence grading is in Additional file 1: Table S6
See this image and copyright information in PMC

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